Value (Business Strategy and Financial Management)

ePoster Presentations

EP-147 - The Virtual Care Effect on Patient Access at Brigham Health

Sunday, April 29
3:45 PM - 4:00 PM
Location: Education Zone, Booth 2416, Screen 5

Many health care systems increasingly face challenges with patient access; Brigham Health (Boston, MA) is not an exception. Our institution has realized value in using virtual care pilot programs to improve patient access. In 2016 the average ambulatory appointment lag time at Brigham and Women's Hospital was fourteen days for surgical departments, and thirty-six days in non-surgical departments. In addition, only forty percent of patients were seen within the timeframe requested by a referring primary care physician. Overall, eighty percent of ambulatory visits are for follow up care, hindering provider's ability to meet new patient demand.
In efforts to provide care for existing patients while accommodating new patient demand, our team is strategically expanding three key virtual care programs: virtual visits, eVisits, and eConsults. We strongly believe that expansion will improve patient access, engagement and experience.
As we scale our virtual visits program across the institution, we are targeting specific surgical and medical specialties with access challenges and strategic value to the organization. The specialty providers determine each patient's clinical appropriateness for program enrollment. Patients have enjoyed the convenience and flexibility that virtual visits offer, and by reducing or eliminating time needed for the waiting room, administrative duties, and rooming, providers typically complete a virtual visit in half the time scheduled for a routine office visit. This efficiency directly improves access by allowing office visits to become available for new or complex established patients. We will describe this effect with our organizational dashboard designed around telehealth.
The Brigham Health E-Visit program consists of a virtual tool that improves patients' access to their primary care providers (PCPs). The patient completes an online questionnaire; the provider reviews the patient's answers and determines the plan of care. The goal of the E-Visit tool is to control the PCP clinic's urgent primary care walk-in traffic. Providers are often able to virtually recommend at-home treatment for minimal severity conditions; thus, fewer patients need a provider's office visit time. In addition to this patient initiated process, we will pilot provider-initiated E-Visits in the near future. Our presentation will illustrate the E-Visit program's effect on PCP access and project E-Visits' expanded effects after we implement provider-initiated E-Visits.
Finally, providers, often PCPs, refer patients to specialists when they lack the expertise to diagnosis or treat a specific condition. Oftentimes, these referrals are clinically appropriate, but in many cases providers are able to treat the patient with appropriate specialty-specific information. The E-Consult program allows providers to virtually connect with specialists within the EHR to ask patient-specific clinical questions. The responding E-Consultant (specialist) offers expert advice and treatment recommendations. By keeping low severity patient care in a lower cost setting, specialists are able to prioritize new or complex follow up patients. We will demonstrate E-Consults' effect on patient access in our virtual care dashboard.
At the ATA conference, our team will share our lessons learned in scaling our virtual care pilots into organization-wide programs and present an evaluation dashboard used to assess virtual care's effects on patient access.

Learning Objectives:

Dale Ziobro

Project Manager
Brigham and Women's Physician Organization

Dale Ziobro is a Project Manager on the Medical Management Team at Brigham and Women’s Physician Organization. She works on a variety of projects focused on Patient Engagement and Integrated Care Management. Specially, she supports the strategic expansion of the virtual care programs including virtual visits, E-Visits and E-Consults at Brigham Health and the Medicaid Accountable Care Organization (ACO) specialty programs focusing on treating patients with substance abuse and managing non-contracted patients. Dale received her undergraduate degree from Denison University.


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Adam Licurse

Medical Director of Virtual Care
Brigham Health and Partners Healthcare, Center for Population Health

Adam Licurse, MD, is an Associate Medical Director at the Brigham and Women’s Physicians Organization and Partners Healthcare Center for Population Health, and the Medical Director of Virtual Care at Brigham Health. He practices primary care at the South Huntington primary care practice.

At BWH, he leads a number of population health and care redesign efforts, including the Brigham’s patient reported outcome measure (PROMs) program, and its ambulatory Telehealth efforts: E-Visits, Virtual Visits, and E-Consults. In his Partners Population Health Management role, he directs the strategy and implementation of the group's multiple patient engagement and telehealth programs, including efforts in shared decision making, in-office and virtual patient education, online patient communities, remote monitoring, patient texting, and virtual patient self-management.

He has published multiple articles about evidence-based clinical decision-making and financial ties to industry, teaches in BWH’s Clinical Process Improvement Program and the ambulatory curriculum of the BWH medical residency program, and has been an invited panelist and speaker at numerous national conferences on population health, telehealth, and patient engagement.

Adam completed residency training in Internal Medicine at BWH, and earned his MD and MHS at Yale School of Medicine where he graduated cum laude. He graduated from Yale College.


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Daniel Kavanaugh

Brigham and Women's Physician Organization

Daniel Kavanaugh, MBA, Manager, joined the Brigham and Women’s Physician Organization’s (BWPO) Medical Management Team in January 2015. Prior to joining the team, Dan served in multiple positions at Boston Children’s Hospital where he managed the inpatient case management and utilization management department. In 2014, he received his Master of Business Administration at Suffolk University (Boston, MA). As the BWPO’s Program Manager for Technology Driven Care Redesign, Dan focuses on supporting project management teams in achieving the goals of multiple programs. These programs include provider/government incentive programs, electronic health record optimization, and virtual care. Currently, Dan is managing the virtual care program’s transition from pilots to sustainable programs.


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EP-147 - The Virtual Care Effect on Patient Access at Brigham Health

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